In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”

...The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis — all quite common.

NEW YORK (Reuters) - In a move that threatens to further inflame concerns about the rationing of medical care, the nation's leading association of cancer physicians issued a list on Wednesday of five common tests and treatments that doctors should stop offering to cancer patients.

The list emerged from a two-year effort, similar to a project other medical specialties are undertaking, to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed.

...

Although the task force emphasized that its recommendations -- winnowed from about 10 suggestions by oncologists -- were driven by medical considerations, the report makes clear that expense was a major factor. A number of cancer drugs cost nearly $100,000 but extend life a few months or not at all. Widely-used imaging tests cost up to $5,000 yet do not benefit patients.

...

Brawley does not see the effort as leading to health-care rationing. "This is the rational use of health-care, not rationing," he said.

...

ASCO recommends against routine use of four other procedures: chemotherapy for patients with advanced cancers who are unlikely to benefit; advanced imaging technologies such as CT and PET or bone scans to determine the precise stage of both early breast and prostate cancers at low risk for metastasis; and drugs to stimulate white blood cell production in patients receiving chemotherapy if they have a risk of febrile neutropenia, an often-fatal condition marked by fever and abnormally low numbers of certain white blood cells.

“Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly and the disabled would suffer the most under such rationing; and that under such a system, these ‘unproductive’ members of society could face the prospect of government bureaucrats determining whether they deserve health care,” Palin wrote in a note on her Facebook page.

“The provision that President Obama refers to is Section 1233 of HR 3200, entitled ‘Advance Care Planning Consultation.’ With all due respect, it’s misleading for the president to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients,” she continued.

Although I don't agree with these "death panels", I do agree with them that there is to much inefficiency in the medical world leading to unaffordable medical costs.

Big Pharma has too much power at this moment!

Quoting: -=uVo=-

Yea easy for you to say when you live in the Netherlands and have very good socialistic medicine. Here we will still pay more for health care than any other country as we always have, we will have shit health care to boot. They need to use Germany, Switzerland, Denmark etc as good examples of socialistic healthcare. Hell my daughter in Costa Rica gets better and way cheaper health care than I get here in the US and I pay lots more than she ever has.

EKGs -> if you miss long QT syndome -> death. You can diagnose ventricular hypertrophy - marker of hypertension, rhythym disturbances, end organ damage from valve disorders, conduction disturbances...and many of these things are asymptomatic. If you miss some of this stuff, you get a lawsuit.

M.R.I's of back pain -> definitely shouldn't be a first line test, but if the pain doesn't get better after 4-6 weeks, it's either a ct of the back or an MRI.

Antibiotics for mild sinusitis -> first line treatment if it's clear discharge is going to be a nasal steroid. If it's green and mucky, amoxicillin.

Routine stress imaging in asymptomatic patients is not needed.

A radiologist usually don't order CTs of the head for a headache -> it's an ordering doctor -> i.e. neurologist, er doctor, primary care doctor, etc. However, most primary doctors won't get a ct of a head for a "simple headache". If, however, the headache persists for several days, then you do need to rule out a few things like sinusitis, cerebral aneursyms etc.

Lowest doses of medication for reflux is usually OTC pepcid / zantac, etc. By the time anyone gets referred to a gastroenterologist, they need the next level up, usually a PPI (prilosec etc). Even oncologists are being urged to cut back on scans for patients with early stage breast and prostate cancers that are not likely to spread <- this is ridiculous. If you don't stage it right and monitor it's progress, talk about lawsuit city and wrong treatment for that matter. Radiation therapy and surgery for solitary mets would be missed.

kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family. <- wtf? Like anyone in their right mind would allow themselves to be hooked up to a machine 3-4 hours a session, 3 days a week without having a serious discussion. LOL.

As you can see, a lot of this stuff is related to malpractice. Tort reform is needed to fix some of these problems outside of other changes.

I am not for death panels, but I do agree that a lot of waste is dragging the system down. Case in point... 78 year old woman who is depressed (It is really a case of spoiled bitch syndrome, but that is too long of a story ) For the last 20+ years, her ass is carted off to the psychiatrists office twice a month at the cost of about $ 250.00 per visit. Any and all suggestions that the psychiatrist makes to improve the condition are ignored and met with flat out refusal . The patient refuses to help herself in anyway. So you have an insurance company ( Part of a bloated retired teachers compensation package) having to foot a bill of $6000.00 per year so that an old, cranky, woman can get her attention fix.

This is a true story, and this is the type of waste that makes it diffuicult for many in this country to have access to quality and affordable care.

I am not for death panels, but I do agree that a lot of waste is dragging the system down. Case in point... 78 year old woman who is depressed (It is really a case of spoiled bitch syndrome, but that is too long of a story ) For the last 20+ years, her ass is carted off to the psychiatrists office twice a month at the cost of about $ 250.00 per visit. Any and all suggestions that the psychiatrist makes to improve the condition are ignored and met with flat out refusal . The patient refuses to help herself in anyway. So you have an insurance company ( Part of a bloated retired teachers compensation package) having to foot a bill of $6000.00 per year so that an old, cranky, woman can get her attention fix.

This is a true story, and this is the type of waste that makes it diffuicult for many in this country to have access to quality and affordable care.

Quoting: Anonymous Coward 13390507

I agree with you. I was depressed about my daughter moving out and not letting me see my grand kids for several months so Kaiser had me go to a psychologist, I went twice, she kept looking at the clock and told me to take my computer to the park and I may meet people and make new friends. I saw the bill they were charging the insurance company and canceled all other apts. I could have read a self help book and got more out of it.

I am not for death panels, but I do agree that a lot of waste is dragging the system down. Case in point... 78 year old woman who is depressed (It is really a case of spoiled bitch syndrome, but that is too long of a story ) For the last 20+ years, her ass is carted off to the psychiatrists office twice a month at the cost of about $ 250.00 per visit. Any and all suggestions that the psychiatrist makes to improve the condition are ignored and met with flat out refusal . The patient refuses to help herself in anyway. So you have an insurance company ( Part of a bloated retired teachers compensation package) having to foot a bill of $6000.00 per year so that an old, cranky, woman can get her attention fix.

This is a true story, and this is the type of waste that makes it diffuicult for many in this country to have access to quality and affordable care.

Quoting: Anonymous Coward 13390507

I agree with you. I was depressed about my daughter moving out and not letting me see my grand kids for several months so Kaiser had me go to a psychologist, I went twice, she kept looking at the clock and told me to take my computer to the park and I may meet people and make new friends. I saw the bill they were charging the insurance company and canceled all other apts. I could have read a self help book and got more out of it.

Quoting: Anonymous Coward 2122560

I am certainly not against a person obtaining psychiatric services if they need them, but as I stated in the original post, this person does not follow the doctors advice. 20 years is a long time to run up bills, if there is no improvement in the condition. You can bet your ass that if this old bat were paying out of pocket, she would not be doing this. It is just selfish to have an "I am not paying for it, so why should I care" attitude. She fails to realize that every other person/family enrolled in the plan pays for this through increased premiums.

Cancer treatement is a farce anyway. Moreover, we have to get out of the mind set that we need doctors. We need to take care of ourselves. Doctors are great at setting broken bones, repairing torn muscles, stitching up wounds, but for disease, they have no more of clue than you do.Hippocrates said, 'let they food be thy medicine, and thy medicine be thy food.'

We teach evolution in our schools, so we in affect say that we are no better than a pig. So, why shouldn't they exterminate us when we become what they deem us as drains on society?

If you teach people they are animals, and they believe it, then that's how they should expect to be treated...

truth is sometimes doctor refers a patient to another physician friend to do unnecessary test just to share the wealth around... or prescribe unneeded medicine for their patients just to get more kick back from pharma's... i work in healthcare --- see this all the time . of course not all doctors are like that either...

us. conventional doctors can't find their asses with both hands anyway.I am dealing with a lifelong immune disorder CAUSED BY UNTHINKING FUCKING STUPID DOCTORS which will kill me earlier and my son will walk this earth longer without family. We are close. Prior to this my health was actually quite fine, no "conditions" at all.

All drs should be forced to ingest samples of everything they dump on their patients and risk their useless lives as well.

In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.”

...The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis — all quite common.

NEW YORK (Reuters) - In a move that threatens to further inflame concerns about the rationing of medical care, the nation's leading association of cancer physicians issued a list on Wednesday of five common tests and treatments that doctors should stop offering to cancer patients.

The list emerged from a two-year effort, similar to a project other medical specialties are undertaking, to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed.

...

Although the task force emphasized that its recommendations -- winnowed from about 10 suggestions by oncologists -- were driven by medical considerations, the report makes clear that expense was a major factor. A number of cancer drugs cost nearly $100,000 but extend life a few months or not at all. Widely-used imaging tests cost up to $5,000 yet do not benefit patients.

...

Brawley does not see the effort as leading to health-care rationing. "This is the rational use of health-care, not rationing," he said.

...

ASCO recommends against routine use of four other procedures: chemotherapy for patients with advanced cancers who are unlikely to benefit; advanced imaging technologies such as CT and PET or bone scans to determine the precise stage of both early breast and prostate cancers at low risk for metastasis; and drugs to stimulate white blood cell production in patients receiving chemotherapy if they have a risk of febrile neutropenia, an often-fatal condition marked by fever and abnormally low numbers of certain white blood cells.

There ARE a lot of UNNEEDED Tests and Medications prescribed ... and it COSTS EVERYONE ELSE LOTS OF MONEY to have that unneeded work done.

People hate to hear it, but it has worked well in EVERY industry and process it has been applied to: Statistical Analysis IMPROVES the quality and safety of the process.

The Medical Establishment has FOUGHT against modern Statistical Analysis being applied to medicine precisely because they understand that it WILL take the high earning Doctor out of he loop for certain decisions, decisions that cost everyone a LOT of money and are shown to not make one bit of difference in medical outcomes for the patient.

There is NOTHING WRONG WITH FEWER TESTS BEING DONE IF THOSE TESTS ARE DOING NOTHING TO IMPROVE PATIENT OUTCOMES ... BUT ARE ONLY SERVING TO LINE THE POCKETS OF THE TEST PROVIDERS WITH MONEY!

Personally I have a Living Will ... the major reason being I think it is WRONG to spend massive amounts of society's resources to keep me from meeting my God in order to spend just a few extra days, or weeks, living in a body that can no longer function as human being (ie: live with a quality of life).

I think one of the great things that could be done to reign in health care costs is if is determined that a person is has less than a two week life expectancy then the families can continue massive interventionist medicine ON THEIR NICKLE ... but insurance companies and the Medicare/Medicaid system will no longer be responsible for anything but Hospice and Pain Management type of care.

If FAMILIES HAD TO PAY the actual costs associated with high intervention medicine during the final two weeks of life, versus shoving that cost on everyone else but themselves, you might see a lot more dignity in death returning to our society.

FWIW: If one is truly a Christian then NATURAL Death is nothing to fear. It is a time to celebrate the fact that the person, though they will be missed, has moved on to a better place.